Pathological changes induced by phosphine poisoning: a study on 8 children

Retrospective analysis of 217 fatal intoxication autopsy cases from 2009 to 2021: temporal trends in fatal intoxication at Tongji center for medicolegal expertise, Hubei, China

This retrospective analysis of fatal intoxication case autopsies was performed at Tongji Center for Medicolegal Expertise in Hubei (TCMEH) from 2009 to 2021 to obtain up-to-date information on intoxication cases. The objective was to describe important data about evolving patterns in intoxication occurrences, enhance public safety policies, and assist forensic examiners and police in more efficient handling of such cases. Analyses based on sex, age, topical exposure routes, toxic agents, and mode of death were performed using 217 records of intoxication cases collected from TCMEH as a sample, and the results were compared with reports previously published (from 1999 to 2008) from this institution. Deaths from intoxications occurred at a higher rate in males than in females and were most common among individuals aged 30-39 years. The most frequent method of exposure was oral ingestion. The causative agents of deadly intoxications have changed when compared to the data from the previous 10 years. For instance, deaths from amphetamine overdoses are becoming more prevalent gradually, whereas deaths due to carbon monoxide and rodenticide intoxication have declined dramatically. In 72 cases, pesticides continued to be the most frequent intoxication cause. A total of 60.4% of the deaths were accidental exposure. Men died from accidents at a higher rate than women, although women were more likely to commit suicide. Particular focus is needed on the use of succinylcholine, cyanide, and paraquat in homicides.

Cardiotoxicity of some pesticides and their amelioration

Pesticides are used to control pests that harm plants, animals, and humans. Their application results in the contamination of the food and water systems. Pesticides may cause harm to the human body via occupational exposure or the ingestion of contaminated food and water. Once a pesticide enters the human body, it may create health consequences such as cardiotoxicity. There is not enough information about pesticides that cause cardiotoxicity in the literature. Currently, there are few reports that summarized the cardiotoxicity due to some pesticide groups. This necessitates reviewing the current literature regarding pesticides and cardiotoxicity and to summarize them in a concrete review. The objectives of this review article were to summarize the advances in research related to pesticides and cardiotoxicity, to classify pesticides into certain groups according to cardiotoxicity, to discuss the possible mechanisms of cardiotoxicity, and to present the agents that ameliorate cardiotoxicity. Approximately 60 pesticides were involved in cardiotoxicity: 30, 13, and 17 were insecticides, herbicides, and fungicides, respectively. The interesting outcome of this study is that 30 and 13 pesticides from toxicity classes II and III, respectively, are involved in cardiotoxicity. The use of standard antidotes for pesticide poisoning shows health consequences among users. Alternative safe medical management is the use of cardiotoxicity-ameliorating agents. This review identifies 24 ameliorating agents that were successfully used to manage 60 cases. The most effective agents were vitamin C, curcumin, vitamin E, quercetin, selenium, chrysin, and garlic extract. Vitamin C showed ameliorating effects in a wide range of toxicities. The exposure mode to pesticide residues, where 1, 2, 3, and 4 are aerial exposure to pesticide drift, home and/or office exposure, exposure due to drinking contaminated water, and consumption of contaminated food, respectively. General cardiotoxicity is represented by 5, whereas 6, 7, 8 and 9 are electrocardiogram (ECG) of hypotension due to exposure to OP residues, ECG of myocardial infraction due to exposure to OPs, ECG of hypertension due to exposure to OC and/or PY, and normal ECG respectively.

COVID-19: Asymptomatic Carrier: An Autopsy Case Report

The severe acute respiratory syndrome (SARS)-coronavirus- 2 (CoV-2) outbreak in Wuhan, China has now spread to many countries across the world including the India with an increasing death toll. On March 11, 2020, the new clinical condition COVID-19 (Corona-Virus-Disease-19) was declared a pandemic by the World Health Organization (WHO). Owing to its infectivity, high risk of transmission, and limited handling of dead bodies, published data on the course of diseases has been limited. Most patients with COVID-19 have a mild disease course and remain as asymptomatic carrier; however, few patients of older age and with co-morbidites develop severe disease leading on to fatality. If due to COVID-19 infection death occurs, an autopsy is unlikely. However in unnatural deaths the legal duty impels the proper performance of a full autopsy, to find out the cause and manner of death. The detailed autopsy examination along with histo-pathological findings in the organs of asymptomatic patient of COVID-19 and its comparison with microscopic findings in Aluminium Phosphide poisoning are discussed below. This will summarizes the research status for COVID-19 deaths, which will be important for evaluation of cause of death, prevention, control and clinical strategies of COVID-19.

Modulatory activities of polyphenols on crude acetylene-induced cardiac and hepatic dysfunctions in a rat model

Exposure to crude acetylene can occur in occupational settings. This study assessed the modulatory activities of selected polyphenols on the hematotoxic, cardiotoxic, and hepatotoxic effects of crude acetylene. Wistar rats were exposed to 58 000 ppm crude acetylene for 10 min at 12 h intervals for 30 days. Some exposed groups were treated with 50 mg/kg rutin, quercetin, gallic acid, or tannic acid. Indices of hematological disorder, oxidative stress, and cardiovascular and hepatocellular injuries were evaluated in animals. The results showed a decrease in the levels of hematological indices in crude acetylene-exposed animals except for white blood cell count which was increased. Decreased activity/level of reduced glutathione, superoxide dismutase and ferric reducing antioxidant power with increased lipid peroxidation was observed in animals exposed to crude acetylene. Activities of transaminases, γ-glutamyl transpeptidase, and level of bilirubin were increased while the plasma albumin level was decreased. Dyslipidemia, increased activities of lactate dehydrogenase and creatine kinase-MB, and severe histopathological damage to hepatic and cardiac tissues were also observed in animals exposed to the gas. These deleterious hematological, biochemical, and histopathological changes were ameliorated in crude acetylene-toxified rats treated with the polyphenols. Tannic acid exhibited better activity than gallic acid while quercetin showed a superior activity to rutin. The results indicate that exposure to crude acetylene can lead to blood, heart, and liver-related diseases and dietary polyphenols could provide protective benefits.

Prediction of zinc phosphide-induced hepatotoxicity and cardiotoxicity from clinical, laboratory, and radiological indicators

Zinc phosphide (Zn₃P₂) is a phosphine-generating pesticide. Serious hepatotoxicity or cardiotoxicity might develop late in initially stable patients. The current prospective study aimed to predict Zn₃P₂-induced hepatotoxicity and cardiotoxicity. This prospective cross-sectional study included 150 patients admitted to the Alexandria Poison Center (APC) for over 6 months (from August 2018 to January 2019). The recorded patients' data included personal data, poisoning, medical history, clinical assessment using the poisoning severity score (PSS), investigations, and the outcome. The mean age of the patients was 23.36 ± 13.53 years. Females constituted 68.7%, and 76% of the patients ingested Zn₃P₂ deliberately. Only two cases that ingested the highest amount of Zn₃P₂ had radio-opaque shadows in the abdominal plain X-ray. The peak of clinical manifestations was in 12 h, whereas the peak liver transaminases (alanine aminotransferase (ALT), aspartate aminotransferase (AST)) and cardiac enzymes (creatine phosphokinase (CPK), creatine kinase-muscle/brain (CK-MB), troponin) were in 24 h. No fatalities were reported, 56.7% are completely cured, 37.3% are discharged on consent, and 6% are discharged with elevated liver and/or cardiac enzymes. The receiver operating characteristic (ROC) curve was applied. Persistent elevation of liver enzymes after 72 h could be predicted if the ingested amount > 3.5 (accuracy 86.2%), time till hospitalization > 5 h (accuracy 85.9%), PSS > 1 with (accuracy 58.9%), AST > 50 U/L (accuracy 86.2%), or ALT > 82 U/L (accuracy 86.3%). Elevation of cardiac enzymes could be predicted if the ingested amount > 2.5 sachets (accuracy 99.5%), time till hospitalization > 5 h (accuracy 99.7%), PSS > 1 with (accuracy 61.2%), CPK > 260 U/L (accuracy 99.9%), CK-MB > 6 ng/mL (accuracy 99.7%), or troponin > 0.9 ng/mL (accuracy 99.8%).